We rated Oaks Hospital as good because:

• The hospital was clean with good furnishings and was well maintained throughout.
• Safe staffing levels were maintained at all times and 92% of staff members were up to date with mandatory training.
• All patients were risk assessed using a recognised rating tool. Levels of risk were discussed daily by the multi-disciplinary team and risk management plans adjusted where necessary.
• Staff had a good understanding of safeguarding and incident reporting procedures and we saw there was a thorough investigation procedure in place.
• There was a wide range of professionals within the multi-disciplinary team who worked well together to deliver a comprehensive package of rehabilitative care. We saw the needs of individual patients were discussed in ward rounds, handovers and morning meetings. Staff appeared to have a good understanding of the needs of the patients and we saw how the day was planned to accommodate activities. Patient care records were personalised and covered a wide range of needs, focusing on recovery.
• The patients had regular access to and independent advocacy service. The advocate worked closely with staff to raise any concerns on behalf of the patient.
• The hospital catered for a wide range of nutritional needs, offering a variety of menu options including dietary and religious needs. There was a wide range of facilities and to support care and treatment such as therapy rooms, gym, therapy kitchen, classrooms, football pitch, art room and a pool room.
• Carers spoke positively about the service, they told us the hospital was always clean, staff were polite and always made time to speak with them if required.
• There was a structure to governance procedures. Managers shared results from key performance indicators and discussed best practice.
• Staff, patients and relatives reported that the hospital management team was visible and approachable. There was a good team ethos and we observed good relations between staff at all levels.

However:

• There were some restrictions in place that were not being recorded and reviewed in accordance with the least restrictive practice principle within the Mental Health Act Code of Practice.
• All staff had received training in the Mental Health Act (MHA) however this had not been updated to describe in detail the changes to the code of practice which were introduced in April 2015.
• The provider had not completed adjusting policies and procedures to reflect changes to the MHA Code of Practice and policies were still under review.
• Covert medication was being administered for a physical health condition and this had not been subject to the necessary authority within the Mental Capacity Act.
• Bedrooms on ground level could be looked into by anyone walking by the outside, the provider had not taken steps to promote the privacy and dignity of those inside.
• The hospital did not have a system in place to ensure staff members were in receipt of regular supervision throughout the year.
• There was no formal system in place to ensure staff members at all levels were able to share the learning from incidents.

We spoke with patients about the level of involvement they could have in planning their care and treatment. They told us that they understood how decisions were made about their care and treatment, and understood their legal rights. In our observations of staff and patients, we observed staff spoke with patients treating them with dignity and respect, and took appropriate steps to ensure patients’ privacy was upheld.

Patients we spoke with gave us a mixed view of their experience of being treated at Cambian – Oaks hospital. One patient told us he did not feel staff gave him sufficient motivation and another said: “I think they delay things.” However, another patient was more positive and told us: “The staff are much better than any other hospital I’ve been in.” One patient we spoke with said: “I’m getting the help I need to go back into the community.”

People were protected from unsafe or unsuitable equipment because the provider had appropriate arrangements in place for checking and monitoring the equipment within the hospital.

We checked records of staff employed within Cambian – Oaks Hospital, and found that regular, detailed supervision and appraisal took place. Supervision included discussion about performance, any support needs that staff had, patient wellbeing and development and training opportunities.

Each care plan that we checked contained a high level of detail, so that staff understood how to deliver care and support to ensure patients’ individual needs were met. All the care plans and risk assessments we checked were signed by the staff member writing them, and all the daily notes we checked were also signed, so that staff writing records were accountable.

We spoke with patients who told us they felt the hospital was meeting their needs. One patient told us “I’ll miss it when I’ve left.” Another said “it’s really relaxed.”

We saw that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

The facilities throughout the hospital were clean and well maintained with appropriate floor and surface coverings. Appropriate hand washing procedure information was displayed over the sinks and there were hand washing facilities available for staff and visitors within each of the two units.

There were enough qualified, skilled and experienced staff to meet people’s needs. One patient said to us: “There are enough staff. There are always enough staff for me to go on my leave.”

There was an effective system in place for handling complaints. Patients told us they would be confident to make a complaint and they believed it would be resolved appropriately. One patient said: “I complained and he (the registered manager) sorted it out straight away.”

We spoke with a number of patients, all of whom were extremely positive about their experience of being treated at Cambian – Oaks Hospital. One patient told us “I’m very involved in my care.” Another said “I feel better because of the help I get here.” One patient told us about how his day was structured and said; “We have planning meetings every day, and we plan together what we are going to do.”

People we spoke with were positive about their experience of receiving care at Cambian – Oaks Hospital. One patient told us that he had been treated in other similar services and that this one compared well. Another patient said “it’s ok here, I get on with the staff”.

We spoke with patients who were positive about their experience of being treated at Cambian - Oaks Hospital. They were enthusiastic about the support that staff provided to them, and about how they had received help planning for their futures. One patient told us that he had received treatment in other hospitals and said that this was “the best place I’ve been in”.

Patients told us that they understood how to give feedback to the provider, and that staff supported them to do so if they wished to have help.

We rated Cygnet Oaks as requires improvement because:

• The hospital did not always provide safe care. We identified issues with the safe and proper management of medicines and equipment. Doctors on call out of hours could not attend the hospital quickly if required. Although the provider’s policy stated that remote prescribing should only take place in exceptional circumstances, this happened routinely and the prescribing doctors did not often know patients and their needs. Doctors did not attend the hospital afterwards to sign the prescription. One medication chart reviewed did not contain the route and dose and had not been signed. There were issues with staff not following the as and when required medication protocol for another patient and at the House, the electrocardiogram pads had expired in May 2018.
• We found gaps in the care planning of three patients with physical health needs. This included records not containing information about when blood glucose monitoring should be completed. Where patients had a physical health need, involving skin integrity and bowel activity, there was no care plan in place for staff to follow.
• We also observed that the blood glucose monitoring for two patients with diabetes was completed after they had eaten breakfast.
• In a safeguarding incident, staff had not acted and intervened as soon as they could to protect a patient from abuse.
• Mandatory and compliance training rates for five courses fell below 75%. This included training to ensure that staff had the skills and knowledge to keep people safe.
• The hospital building design limited the accessibility for patients with disabilities and reduced mobility to move around independently without staff support.

However:

• Staff assessed and managed risks well. They balanced risk management against providing a least restrictive environment. The hospital had involved patients in the reviewing of blanket restrictions and had reduced these.
• Patients had access to a full range of professions from multiple disciplines who provided a range of therapies and activities to support patients to get better and develop their skills.
• Staff understood the needs of patients well and treated patients with kindness, respect and compassion.
• Staff managed and planned discharge well. They worked with external services assertively to ensure that discharges were not delayed and patients had aftercare services.
• Leaders were visible and approachable within the service to staff and patients.